This invention relates to an implantable bioerodable composition useful for the repair of living bone and for the administration of biologically active substances. More particularly, this invention relates to a moldable, biocompatible, polyester/particulate composite that can be used for reinforcement of fractures and defects in bone, for fixation of implants and prostheses in bone, and for controlled-release delivery of biologically active agents.
Applicants have found that incorporation of biocompatible calcium phosphate ceramics and resorbable calcium salts into a cross-linked biodegradable polyester matrix produces a cement-like composition having the combined features of developing excellent biomechanical strength within a short cure time and the capacity to degrade progressively, in vivo. permitting, under suitable conditions, eventual replacement of the cement by body tissue. Thus, for example, where the present bioerodable composition is implanted in contact with bone for use to repair skeletal deformities and injuries, to treat infections and diseases, or to "fix" prosthetic appliances in bone, the composition is gradually resorbed and may then be replaced with living bone.
Surgical cements are well known in the art. Such cements are commonly used for implant fixation in the surgical replacement of joint and bone tissue with prosthetic appliances. At the time of surgery the cement, in a fluid or semi-fluid pre-cured form, is injected or otherwise applied between the bone and implant, flowing around the contours of the bone and implant and into the interstices of cancellous bone. Upon hardening (curing), the cement mechanically-interlocks the bone and implant.
Poly(methyl methacrylate) (PMMA) is the most widely used bone cement. PMMA cement comprises two components, a powder of prepolymerized methyl methacrylate and a liquid monomer, methyl methacrylate, that are mixed at the time of surgery to form a paste-like cement material. PMMA cement is "permanent" in the sense that it is not degraded within the body. However, PMMA does not always provide "permanent" implant fixation. Loosening of prosthetic appliances due to cement failure has long been recognized as the single most prevalent problem in conventional prosthetic arthroplasty, placing a serious limitation on the successful duration of joint and bone replacement surgery. PMMA cement can sustain fatigue damage and has been known to crack and fail due to biomechanical overstressing. Yet another problem encountered with the current PMMA bone cement is that of the resorption of bony tissue immediately adjacent to the bone cement associated with the formation of a biologically active fibrous tissue membrane. Inducement of the formation of this membrane, which contains bone resorbing cells and enzymes, may be a second mechanism, in addition to biomechanical overstressing, whereby PMMA cement loses its purchase in the surrounding bone and thereby fails to provide secure implant fixation.
More recent research efforts concerning fixation of bone prostheses have been directed to development of bone cements that are more compatible with bone tissue and to definition of implant surfaces capable of receiving direct bone ingrowth to enhance the bone-implant interlock. For example, prosthetic appliances have been constructed with a highly porous coating on their bone-contacting surfaces, providing interstices into which bone tissue can grow to effect direct bone fixation of the implant. For a bone to interlock with the porous surface structure of the implant, however, the implant must be firmly fixed at the time of surgery and load application must be minimized during the ingrowth period. This fixation method is, therefore, not entirely satisfactory because it is very difficult to provide adequate immobilization and stabilization of the implants during the bone ingrowth process. Further it is impossible to achieve bone ingrowth if a sufficiently large gap exists between the patient's bone and the porous implant surface.
One embodiment of the present invention relates to the use of a cross-linked biodegradable polyester/particulate composite for surgical bone repair and implant fixation. The invention is based on the discovery that particles of biocompatible sintered calcium phosphate ceramics and more porous and resorbable calcium salts can be incorporated into a cross-linked biodegradable polymer matrix to produce a surgical cement possessing physical and biological properties that are superior to conventional fixation cements. The polymer matrix is a biodegradable polyester solidified, or cured, immediately following placement in vivo by reaction with a chemical cross-linking agent. The polymer matrix serves as a supporting binder for particles of biocompatible inorganic salts and ceramics. The cured cement exhibits excellent biomechanical properties within short cure times. A patient receiving an implant fixed using the present cross-linked polyester composite as a cement could be ambulatory early after surgery, thereby facilitating rapid rehabilitation and minimizing costly hospitalization.
The polyester composite of this invention is formulated to allow a unique multi-stage process in which the cement is gradually resorbed and could be replaced in vivo under suitable conditions by growing natural bone. Thus an implant originally secured using the present cement could, with time, be secured by direct contact with living bone. Initially, particulate calcium salts in the cement are eluted from the polyester matrix by body fluids creating small voids or cavities in the polymer matrix. Over time, the more slowly resorbable particulate ceramic component is wholly or partially resorbed, and the polyester matrix itself degrades in vivo into its component non-toxic assimilable dicarboxylic acids, and dihydric or polyhydrlc alcohols. As the matrix of the cement slowly degrades voids are formed which can be filled in by new bone. Eventually the extent of the new bone ingrowth could contact and secure the prosthetic appliance. The extent of new bone ingrowth will vary depending upon local conditions affecting the implant. For instance, new bone ingrowth can be expected only if the bone cement is implanted intraosseously as opposed to subcutaneously or intramuscularly. Furthermore, cancellous bone, with its greater blood supply, is more likely to facilitate bone ingrowth than cortical bone. The presence of an infecting organism would have an adverse affect on ingrowth. Proportionally less ingrowth will occur with a large amount of implanted cement. Mixing host bone into the cement before use could facilitate bulk regrowth and new bone ingrowth.
In contrast to the situation mentioned above where a PMMA-fixed prosthesis can work loose with formation of surrounding fibrous tissue, living bone is able to heal and to remodel itself in response to stress; it is, therefore, resistant to the problem of failure with repeated loading. This invention represents a significant improvement in bone implant methodology.
It is known in the bone cement art to combine a bioresorbable particulate compound such as tricalcium phosphate with a non-biodegradable polymeric resin. See, for example, U.S. Pat. No. 4,373,217; U.K. Application No. 2,156,824; J. Vanio, Arch. Orthop. Traumat. Surg., 92, 169-174 (1978). However, such compositions do not function in vivo as does the cement of this invention. Because polymer resins of prior art composites are not biodegradable, prior art composite cements cannot be replaced by growing bone tissue.
The use of biodegradable polymers in vivo is also known in the art. Biodegradable polymers have been described for a variety of applications, including controlled release dosage forms and bioresorbable sutures. See U.S. Pat. Nos. 3,463,158; 4,080,969; 3,997,512; 4,181,983; 4,481,353; and 4,452,973. Ibay et al. describe the preparation and use of moldable implant appliances from vinylpyrrolidone cross-linked poly(propylene glycol fumarate) (PPF) for use as temporary replacements for soft tissue and/or bone following trauma. A. C. Ibay et al., Polymer Material Science and Engineering, 53, 505-509 (1985). Absorbable polyglycolic acid suture has been used successfully for internal fixation of fractures. B. Roed-Peterson, Int. J. Oral. Surg., 3, pp. 133-136 (1974). There is nothing, however, to suggest use of cross-linked biodegradable polymer composites for implant fixation. Nor is there any suggestion to combine biodegradable cross-linkable polyesters with biocompatible particulate calcium salts and ceramics to form the present particulate/polymer composites finding use as bone cements and as effective delivery systems for the sustained-release of biologically active substances.
It is therefore, an object of this invention to provide a biocompatible resorbable surgical cement for repairing living bone.
It is another object of this invention to provide a method for permitting bone ingrowth and bone adhesion to implanted prostheses.
Another object of this invention is to provide a biodegradable implantable composite comprising a cross-linked biodegradable organic polymer in combination with particulate, biocompatible calcium phosphate ceramics and a resorbable calcium salts.
Still a further object of this invention is the use of particulate/cross-linked polyester composites as means for sustained-release delivery of drugs for treatment of disease in warm-blooded vertebrates, and drug depot devices utilizing said composites .